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Sore throat

Overview

A sore throat is pain, scratchiness or irritation of the throat that often worsens when you swallow. The most common cause of a sore throat (pharyngitis) is a viral infection, such as a cold or the flu. A sore throat caused by a virus resolves on its own.

Strep throat (streptococcal infection), a less common type of sore throat caused by bacteria, requires treatment with antibiotics to prevent complications. Other less common causes of sore throat might require more complex treatment.

Symptoms

Symptoms of a sore throat can vary depending on the cause. Signs and symptoms might include:

  • Pain or a scratchy sensation in the throat
  • Pain that worsens with swallowing or talking
  • Difficulty swallowing
  • Sore, swollen glands in your neck or jaw
  • Swollen, red tonsils
  • White patches or pus on your tonsils
  • Hoarse or muffled voice

Common infections causing a sore throat might result in other signs and symptoms, including:

  • Fever
  • Cough
  • Runny nose
  • Sneezing
  • Body aches
  • Headache
  • Nausea or vomiting

When to see a doctor

Take your child to a doctor if your child's sore throat doesn't go away with the first drink in the morning, recommends the American Academy of Pediatrics.

Get immediate care if your child has severe signs such as:

  • Difficulty breathing
  • Difficulty swallowing
  • Unusual drooling, which might indicate an inability to swallow

If you're an adult, see your doctor if you have a sore throat and any of the following associated problems occur, according to the American Academy of Otolaryngology:

  • A sore throat that is severe or lasts longer than a week
  • Difficulty swallowing
  • Difficulty breathing
  • Difficulty opening your mouth
  • Joint pain
  • Earache
  • Rash
  • Fever higher than 101 F (38.3 C)
  • Blood in saliva or phlegm
  • Frequently recurring sore throats
  • A lump in your neck
  • Hoarseness lasting more than two weeks
Throat anatomy

Your throat includes your esophagus, windpipe (trachea), voice box (larynx), tonsils and epiglottis.

Causes

Viruses that cause the common cold and flu (influenza) also cause most sore throats. Less often, bacterial infections cause sore throats.

Viral infections

Viral illnesses that cause a sore throat include:

  • Common cold
  • Flu (influenza)
  • Mononucleosis (mono)
  • Measles
  • Chickenpox
  • Croup — a common childhood illness characterized by a harsh, barking cough

Bacterial infections

A number of bacterial infections can cause a sore throat. The most common is Streptococcus pyogenes, or group A streptococcus, which causes strep throat.

Other causes

Other causes of a sore throat include:

  • Allergies. Allergies to pet dander, molds, dust and pollen can cause a sore throat. The problem may be complicated by postnasal drip, which can irritate and inflame the throat.
  • Dryness. Dry indoor air, especially when buildings are heated, can make your throat feel rough and scratchy, particularly in the morning when you wake up. Breathing through your mouth — often because of chronic nasal congestion — also can cause a dry, sore throat.
  • Irritants. Outdoor air pollution can cause ongoing throat irritation. Indoor pollution — tobacco smoke or chemicals — also can cause a chronic sore throat. Chewing tobacco, drinking alcohol and eating spicy foods also can irritate your throat.
  • Muscle strain. You can strain muscles in your throat by yelling, such as at a sporting event; talking loudly; or talking for long periods without rest.
  • Gastroesophageal reflux disease (GERD). GERD is a digestive system disorder in which stomach acids or other contents of the stomach back up in the food pipe (esophagus). Other signs or symptoms may include heartburn, hoarseness, regurgitation of stomach contents and the sensation of a lump in your throat.
  • HIV infection. A sore throat and other flu-like symptoms sometimes appear early after someone is infected with HIV. Also, someone who is HIV-positive might have a chronic or recurring sore throat due to a secondary infection, such as a fungal infection called oral thrush and cytomegalovirus (CMV) infection, a common viral infection that can be serious in people with compromised immune systems.

    Both oral thrush and CMV can occur in anyone, but they're more likely to cause a sore throat and other symptoms in people with weakened immune systems.

  • Tumors. Cancerous tumors of the throat, tongue or voice box (larynx) can cause a sore throat. Other signs or symptoms may include hoarseness, difficulty swallowing, noisy breathing, a lump in the neck, and blood in saliva or phlegm.

Rarely, an infected area of tissue (abscess) in the throat causes a sore throat. Another rare cause of a sore throat is a condition that occurs when the small cartilage "lid" that covers the windpipe swells, blocking airflow (epiglottitis). Both causes can block the airway, creating a medical emergency.

Risk factors

Although anyone can get a sore throat, some factors make you more susceptible, including:

  • Age. Children and teens are most likely to develop sore throats. Children are also more likely to have strep throat, the most common bacterial infection associated with a sore throat.
  • Exposure to tobacco smoke. Smoking and secondhand smoke can irritate the throat. The use of tobacco products also increases the risk of cancers of the mouth, throat and voice box.
  • Allergies. Seasonal allergies or ongoing allergic reactions to dust, molds or pet dander, make developing a sore throat more likely.
  • Exposure to chemical irritants. Particles in the air from burning fossil fuels and common household chemicals can cause throat irritation.
  • Chronic or frequent sinus infections. Drainage from your nose can irritate your throat or spread infection.
  • Close quarters. Viral and bacterial infections spread easily anywhere people gather, whether in child care centers, classrooms, offices or airplanes.
  • Weakened immunity. You're more susceptible to infections in general if your resistance is low. Common causes of lowered immunity include HIV, diabetes, treatment with steroids or chemotherapy drugs, stress, fatigue, and poor diet.

Diagnosis

Your or your child's doctor will start with a physical exam that will include:

  • Using a lighted instrument to look at the throat, and likely the ears and nasal passages
  • Gently feeling (palpating) the neck to check for swollen glands (lymph nodes)
  • Listening to your or your child's breathing with a stethoscope

Throat swab

With this simple test, the doctor rubs a sterile swab over the back of the throat to get a sample of secretions. The sample will be checked in a lab for streptococcal bacteria, the cause of strep throat. Many clinics are equipped with a lab that can get a test result within a few minutes. However, a second, often more-reliable test is sometimes sent to a lab that returns results within 24 to 48 hours.

If the rapid, in-clinic test comes back positive, then you almost certainly have a bacterial infection. If the test comes back negative, then you likely have a viral infection. Your doctor might wait, however, for the out-of-clinic lab test to determine the cause of the infection.

Treatment

A sore throat caused by a viral infection usually lasts five to seven days and doesn't require medical treatment. However, to ease pain and fever, many people turn to acetaminophen (Tylenol, others) or other mild pain relievers. Use acetaminophen for the shortest time possible and follow label directions to avoid side effects.

Consider giving your child over-the-counter (OTC) pain medications designed for infants or children. These include acetaminophen (Tylenol, Infant's Feverall, others) or ibuprofen (Pediatric Advil, Motrin Infant, others) to ease symptoms.

Use caution when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.

Treating bacterial infections

If your sore throat is caused by a bacterial infection, your doctor will prescribe antibiotics.

You must take the full course of antibiotics as prescribed even if the symptoms are gone. Failure to take all of the medication as directed can result in the infection worsening or spreading to other parts of the body. Not completing the full course of antibiotics to treat strep throat can increase a child's risk of rheumatic fever or serious kidney inflammation.

Talk to your doctor or pharmacist about what to do if you forget a dose.

Other treatments

If a sore throat is a symptom of a condition other than a viral or bacterial infection, other treatments will likely be considered depending on the diagnosis.

Alternative medicine

Although a number of alternative treatments are commonly used to soothe a sore throat, evidence is limited about what works. If you need an antibiotic for a bacterial infection, don't rely on alternative treatments alone.

Check with your doctor before using any herbal remedies, as they can interact with prescription medications and may not be safe for children, pregnant women and people with certain health conditions.

Herbal or alternative products for a sore throat are often packaged as teas, sprays or lozenges. Common alternative remedies include:

  • Slippery elm
  • Licorice root
  • Marshmallow root
  • Honeysuckle flower and other Chinese medicine herbs

Preparing for an appointment

If you or your child has a sore throat, make an appointment with your family doctor or your child's pediatrician. In some cases, you may be referred to a specialist in ear, nose and throat (ENT) disorders or an allergy specialist (allergist).

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

  • Symptoms you or your child has, and for how long
  • Key personal information, such as recent contact with someone who was ill
  • All medications, vitamins or other supplements you or your child takes, including doses
  • Questions to ask the doctor.

For a sore throat, some basic questions to ask your doctor include:

  • What's likely causing these symptoms?
  • Are there other possible causes?
  • What tests are needed?
  • What treatment do you recommend?
  • How soon do you expect symptoms to improve with treatment?
  • How long will this be contagious? When is it safe to return to school or work?
  • What self-care steps might help?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask questions about you or your child. Your doctor might ask:

  • Are there symptoms other than a sore throat?
  • Have these symptoms included a fever? How high?
  • Has there been difficulty breathing?
  • Does anything worsen the sore throat, such as swallowing?
  • Does anything seem to make the symptoms better?
  • Has anyone else at home been ill?
  • Is a sore throat a recurring problem?
  • Do you smoke? Are you or your child regularly exposed to secondhand smoke?

Lifestyle and home remedies

Regardless of the cause of your sore throat, these at-home care strategies can help you ease your symptoms:

  • Rest. And rest your voice.
  • Drink fluids. Fluids keep the throat moist and prevent dehydration. Avoid caffeine and alcohol, which can dehydrate you.
  • Try comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water with honey — and cold treats such as ice pops can soothe a sore throat.
  • Gargle with saltwater. A saltwater gargle of 1/4 to 1/2 teaspoon of table salt to 4 to 8 ounces of warm water can help soothe a sore throat. Gargle the solution and then spit it out.
  • Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat or sit for several minutes in a steamy bathroom.
  • Consider lozenges or hard candy. Either can soothe a sore throat, but don't give them to children age 4 and younger because of choking risk.
  • Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.

Prevention

The best way to prevent sore throats is to avoid the germs that cause them and practice good hygiene. Follow these tips and teach your child to do the same:

  • Wash your hands thoroughly and frequently, especially after using the toilet, before eating, and after sneezing or coughing.
  • Avoid sharing food, drinking glasses or utensils.
  • Cough or sneeze into a tissue and throw it away. When necessary, sneeze into your elbow.
  • Use alcohol-based hand sanitizers as an alternative to washing hands when soap and water aren't available.
  • Avoid touching public phones or drinking fountains with your mouth.
  • Regularly clean telephones, TV remotes and computer keyboards with sanitizing cleanser. When you travel, clean phones and remotes in your hotel room.
  • Avoid close contact with people who are sick.

Last updated: April 27th, 2016

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